The choice to give birth

NEW PLEDGES of $4.3 billion from governments, non-governmental organisations and foundations should make it possible to provide contraception for 120 million of the estimated 220 million women around the developing world who want, but cannot get, reliable access to family planning.

That should mean, family planning groups argue, some 110 million fewer unintended pregnancies, over 50 million fewer abortions, and nearly three million fewer babies dying in their first year of life. The pledges were made this week at the London Summit on Family Planning organised by the British government, the United Nations population agency, and the Bill and Melinda Gates Foundation, which alone committed some $560 million.

Melinda Gates argues that the time has come to push contraception back to the top of the development agenda. The foundation, like others, had switched its early family planning emphasis to one on providing vaccines after accepting that childhood mortality was the “top issue” – women would not choose to have fewer children until they were sure they would survive childhood. “Once we saw that was happening, we could take family planning back on,” she says.

Conference organisers estimate that this year, 800 women will die daily as a result of pregnancy-related complications, the leading cause of teenage girl deaths in the developing world. A report from Save the Children finds that girls under 15 are five times more likely to die from pregnancy-related causes than women in their 20s, while nearly a million babies born to adolescent mothers die every year.

Researchers from New York’s Johns Hopkins University say their new findings show that fulfilling women’s unmet contraception demand in developing countries could reduce global maternal mortality by a third. The study finds that birth control reduces health risks by delaying first pregnancies which carry higher risks in the very young; by cutting down unsafe abortions – some 13 per cent of developing world maternal deaths; and by controlling dangers associated with too-closely-spaced pregnancies. The research shows that the number of maternal deaths in developing countries in 2008 would have nearly doubled had it not been for contraception, and that an extra 29 per cent of the deaths could have been prevented if birth control was available to women who wanted it.

Access to contraception is not a lifestyle choice issue but a matter of life and death in the developing world. It must form a central part of any development strategy.

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